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Determinants of recent HIVST uptake among Jiangsu MSM: a cross-sectional survey

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BACKGROUND: China adopted HIV self-testing (HIVST) to expand HIV testing among hard-to-reach key populations that may otherwise not test due to factors like stigma and discrimination. To help inform HIVST upscale plans, our study evaluated the recent use of HIVST among Chinese men who have sex with men (MSM) in Jiangsu province
METHODS: We conducted an online survey from March and April 2020. Data on socio-demographic characteristics, HIV testing history, and attitudes towards HIVST were collected. Men biologically born males, 16 years and above, ever had anal sex with other men in the last 6 months, and ever tested for HIV were eligible for inclusion. Differences between participants who had ever self-tested and those who had never self-tested were evaluated using Pearson's chi-square test. Logistic regression was used to investigate associations between socio-demographic, sexual history, and HIVST experience between two subgroups. P-value < 0.05 was statistically significant.
RESULTS: Of the total 692 eligible participants surveyed, 69.5% (481) were aged between 18-40 years, and 67.5% (467) self-identified as homosexuals. HIVST uptake was barely above average as only 65.9% (456) had ever self-tested. 16.6% (71/467) of self-testers and 14.4% (31/236) of non-self-testers were living with HIV (PLWH). 76.1% (54/71) of PLWH used HIVST for their first-ever HIV test and obtained reactive results. Sexual orientation disclosure to others (AOR=10.96, 95% CI 6.65-18.05) was associated with having ever self-tested. Additionally, having used HIVST for the first HIV test (AOR=1.97, 95% CI: 1.20-3.23) was associated with recent HIVST. HIVST being more private (AOR=1.53, 95% CI: 0.93-2.52) and not needing to go to a health facility (AOR=1.61, 95% CI: 1.17-2.22) were also factors associated with recent HIVST. Regardless of cited disadvantages, 84.3% (199) of never self-tested participants were likely to use HIVST if recommended by a healthcare provider or sexual partner.
CONCLUSIONS: HIVST uptake among Jiangsu MSM is still less than optimal and needs to be promoted. MSM who visit healthcare facilities should be encouraged to help in distributing HIVST kits to their sexual partners and peers. Moreover, healthcare providers should provide more information and recommend the use of HIVST to their key population clients.